Healthcare Provider Details

I. General information

NPI: 1013664457
Provider Name (Legal Business Name): VICKI L PENNER LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 W 6TH ST
LAWRENCE KS
66044-2219
US

IV. Provider business mailing address

1312 W 6TH ST
LAWRENCE KS
66044-2219
US

V. Phone/Fax

Practice location:
  • Phone: 785-841-7297
  • Fax: 785-856-0375
Mailing address:
  • Phone: 785-841-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06576
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: